MEDICINE MAN WEST LLC
15837 N Westwood Dr
Rathdrum, ID 83858
208-687-5717
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
N | 3336M0002X | Suppliers - Pharmacy - Mail Order Pharmacy | ||
N | 3336C0004X | Suppliers - Pharmacy | ||
Y | 3336C0003X | Suppliers - Pharmacy | ID | 1513RP |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
PK | 2021740 | OTHER | |
805797600 | ID | MEDICAID |